儿童胸腰椎骨折脱位的外科治疗

Surgical treatment for fracture and dislocation of thoracolumbar vertebra in children

目的探讨儿童胸腰椎骨折脱位的伤情特点及椎弓根钉固定手术方法与疗效。方法自2000年1月至2007年12月，对15例胸腰椎骨折脱位并伴有不同程度脊髓神经损伤的患儿，男11例，女4例。年龄5～12岁，平均7岁8个月，采用胸腰椎后路复位、减压，同时行椎弓根钉系统内固定术。结果15例患儿术后随访10～48个月，平均32个月，术后X线检查显示伤椎高度恢复50％～80％，脊椎脱位都得到纠正，椎弓根钉位置好，未见松动、断裂。无一例发生血管损伤及感染。术前不同程度的脊髓神经损伤症状除了2例全瘫患儿无恢复外，其他病例在术后均得到不同程度的恢复。结论儿童胸腰椎骨折脱位属于高能量损伤，创伤严重，常伴有不同程度脊髓神经损伤及合并伤；椎弓根钉固定治疗儿童胸腰椎骨折脱位是一种安全、可行方法，达到重建脊柱稳定性，解除脊髓神经受压，便于术后护理及提高患儿生活质量。

Objective To describe the traumatic characteristic of fracture and dislocation of thoracolumbar vertebra in children and to investigate method and the effect of pedicle screw fixation in thoraeolumbar of children. Methods Fifteen patients with fracture and dislocation of thoracolumbar and with different degree of neurological injury were administered from Jan. of 2000 to Dec. of 2007, including 11 male, 4 female, aged from 5 to 12 years （average, 7 years and 8 months）. They underwent posterior surgery in thoracolumbar with positioning, decompression and with pedicle screw fixation. Results The follow up was obtained for 10-48 months （average, 32months）. X ray showed that the altitude of traumatic vertebral bodies recover to 50%-80% post-operation. Dislocation in vertebral bodies was retrieved completely. The positions of all pedicle screws were good. The pedicle screws were not loosened or collapsed. There was no spinal cord or vessel injury or infection. The spinal cord injuries improved after operation except tow cases which were complete paralysis. Conclusions Fracture-dislocation of thoraeolumbar in children is serious injury, and always companied with the spinal cord injuries and severe complications. It is safe and feasible to perform thoracic and lumbar pedicle screw placement in children with fracture-dislocation of thoraeolumbar. This surgery can restitute stabilization of thoracic and lumbar vertebra, decompress of spinal cord, and improve life quality of patients.